“No Bones About It”-Sciatica: More than just a “pain in the butt”

Ever have a burning pain in one of your buttocks and not know why? Ever have a shooting pain down one of your legs and not know why? What about numbness in one of the lower legs?

Your “pain in the butt” may well be a condition known as “sciatica.”

There is considerable debate as to whether or not sciatica is a condition in itself, or merely a symptom of one. In this country, as much as 10 percent of the population can be affected by sciatica. It can affect men and women equally and is frequently seen between the ages of 25 and 45. The older population also can be affected by the degenerative form.

Before you say, “that’s what I have!” or “that’s me all over!” let’s get a better idea of just what sciatica is.

Sciatica refers to a condition brought about by either acute (sudden) or chronic pressure upon the sciatic nerve, which is a nerve that exits the lower lumbar spine on each side of the body, through the buttocks and extends down both legs. This nerve forms when several of the lumbar spinal nerves come together as they exit the spinal column. It ultimately branches off to form other nerves that supply sensation and muscle activity to various parts of the leg, foot and toes.

The pain associated with sciatica is typically caused by some kind of pressure being exerted on the nerve itself. One bad actor notorious for this is the infamous bulging lumbar disc. The disc is like a jellyroll - soft inner tissue surrounded by a ring of more dense cartilage. The disc can bulge form many reasons, most commonly injury or degeneration.

The spinal nerves exit the bony spinal column through very small openings called foramen. There is very little extra space between the nerve and bone, so even the most minimal encroachment, like bulging disc material can cause significant pressure. This pressure can cause pain, numbness and tingling from the low back to the buttocks and down to the lower leg.

Another villain is bone spur formation. These spurs can form from chronic degeneration of the bones of the spinal column, as well as chronic disc degeneration.

As we age, the discs in our spinal column, from the neck to the tailbone, age right along with us. They become increasingly brittle and dehydrated. This can lead to the breakdown of the inner disc material, leaving its outer ring to bear the brunt of supporting the spine and vertebrae. As this occurs, there is increased pressure being placed on the tiny joints that exist between each vertebra, called facet joints. As the disc degenerates, it begins to bulge, just like a tire low on air.

While all this is going on, the vertebrae are developing bone spurs, as are the facet joints, in response to increased motion of these spine segments. This, too, can cause narrowing of the small openings, or foramen, where the nerves exit, exerting pressure on the nerves exiting the spine, which causes, you guessed it, sciatic pain and numbness.

Symptoms are pretty straightforward: pain / numbness and tingling in the low back, one or both buttocks, with radiation that can extend as far down the lower extremities as the feet and toes. Many people describe it as a toothache-type pain, which can worsen with prolonged sitting or standing, heavy lifting and straining.

Diagnosing sciatica is typically a multi-faceted undertaking. It starts with a good physical and neurologic examination by the doctor. X-rays of the lumbar spine are almost always obtained, and can really show bone degeneration. X-rays cannot, however, show any abnormalities of the soft, fleshy structures of the discs. To see those well, many people undergo an MRI, CT scan or lumbar myelogram (injection of dye into the spinal sac) together with a post-myelogram MRI or CT scan. This combination can produce exceptionally detailed pictures of the spinal sac, nerves and discs, showing where and how much pressure is being exerted in the nerve(s).

Treatment can involve, medication; analgesics and anti-inflammatory drugs, physical therapy and occasionally, for the situations where conservative methods fail, surgery.

So, if you have a nagging pain in the butt, and perhaps some numbness or tingling, you can’t explain, you may have that dreaded “pinched nerve” condition known as sciatica. It should be looked at sooner rather than later.

Chisholm’s expertise in nursing, orthopedics and surgery spans more than thirty years. He holds multiple national certifications in these specialties. His goal is to empowering people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care. Visit www.bone-and-joint-pain.com for more information.